Management of splenic abscess in immunocompromised children

Conservative management of isolated splenic abscess in children

“…Although, generally, immunosuppression and concurrent systemic disease are recognized as predisposing factors [13,14], enteric fever, tuberculosis, and parasitic diseases are increasingly being reported as etiologic factors from developing countries [5,7]. There has also been a change in causative organism, with gram-negative bacteria being the commonest isolated in recent reports [4,12,15], whereas previously, gram-positive cocci were the more frequently reported [16].…”

Splenic abscess in an infant caused by Streptococcus intermedius

“…1-3 There has been a recent increase in the number of patients associated with immunocompromised states, for example, due to chemotherapy for malignancies, immunosuppressive therapy for stem cell transplantation, diabetes mellitus, and congenital or acquired immunodeficiency. [4][5][6] Our patient had neither predisposing factors nor an immunocompromised condition, thus suggesting the possibility of hematogenous infection with no underlying disease.…”

Management of splenic abscess in children by percutaneous drainage

“…Isolated abscesses of the spleen are a rarity in children but are being increasingly recognized in association with an immunocompromised state [8,18]. In large series and reviews that include both the adult and pediatric population, the etiologic factors recognized are metastatic infection from other sites in the body, such as bacterial endocarditis [1,15], secondary infection of splenic infarction such as hemoglobinopathies [19], trauma to the spleen, immunodeficiency state, and rarely contiguous infection by direct spread [6].…”

“…The common organisms isolated from culture of the abscess are staphylococci, streptococci, Salmonella, Escherichia, and enterococci [1,5,6]. However, mycobacteria such as Mycobacterium tuberculosis or M avium-intracellulare and fungi such as Candida and Aspergillus [6,8] are increasingly being reported in immunocompromised patients and those with AIDS or after chemotherapy [18]. Blood culture is reported to be positive in 48% cases [6], whereas abscess aspirate culture positivity varies from 73% [6] to 14 % [13] and is usually monomicrobial.…”

“…Metastatic infection from other parts of the body is the most common etiology, although recently, an increasing number of cases are being recognized as being secondary to immunocompromised state resulting from hematologic disorders, transplantation, AIDS, or cancer chemotherapy [6,7]. Staphylococcus, Streptococcus, Salmonella, and Escherichia are the usual organisms isolated, although Candida and atypical mycobacteria are common in immunocompromised children [6,8]. The clinical presentation includes fever, left upper abdominal pain, leukocytosis, leftsided pleural effusion, and splenomegaly [6]; however, fever and leukocytosis may be absent in immunocompromised 0022-3468/$ -see front matter D 2006 Elsevier Inc. All rights reserved.…”